CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
AFRICA
443
less than 30 kg/m
2
.
We excluded women with severe liver, renal
and cardiovascular disorders, and those who were on medication.
Women on hormone replacement or lipid-reducing therapy,
antihypertensive drugs and non-steroidal anti-inflammatory
drugs (NSAIDs) were also excluded.
Variables included age, weight, height, WC, WHR, CI and
fat mass. Systolic and diastolic blood pressure, and laboratory
variables including fasting blood glucose, insulin, low-density
lipoprotein cholesterol (LDL-C), high-density lipoprotein
cholesterol (HDL-C) and total cholesterol (TC) levels were
measured. All participants were asked to complete a three-day
dietary-recall questionnaire and a food-frequency questionnaire.
Weight, height, and hip and waist circumference were
measured using standard procedures. Weight was measured to
the nearest to 0.1 kg, without shoes and wearing light clothing.
Height was recorded to the nearest 0.1 cm. WC was measured
using a rubber measuring tape, horizontally halfway between the
lower border of the rib cage and the iliac crest. Hip circumference
(
HC) was measured at the widest part over the buttocks. WC
and HC were measured to the nearest 0.5 cm. The WHR was
calculated by dividing the WC (cm) by the HC (cm). BMI was
determined as weight (kg) divided by height (m
2
).
The CI was
calculated using weight (kg), height (m) and WC (m) as follows:
Conicity index
=
waist circumference (m)
______________________
√
__
0.109
√
____ ___ _ ___
weight (kg)/height (m)
Fat mass was determined by BIA (Body Stat, UK). Blood
pressure was measured after 10 minutes’ rest, with the subjects
in a seated position. Systolic and diastolic blood pressure (SBP
and DBP, respectively) were measured with two readings at
one-minute intervals. The mean was the average of two readings.
All measurements were recorded to the nearest 2 mmHg.
Following at least 12 hours’ fast, blood was taken for
assessment of total cholesterol (TC), fasting blood glucose
(
FBS), triglyceride, HDL-C and LDL-C levels. These were
determined by enzymatic procedures (Pars Azmon Kit, Tehran,
Iran). Plasma insulin level was measured by ELISA (Diaplus Inc.
Kit, North York, ON, Canada).
Diabetes was defined as a history of diabetes diagnosed by
a physician, taking hypoglycaemic medication, or having a FBS
level more than 126 mg/dl.
Statistical analyses
Descriptive statistics for variables were used with tables, means
and standard deviations. The association of WC, WHR and
CI with lipid profiles, blood pressure, serum insulin and FBS
levels was determined with Pearson’s correlation coefficient.
One-way analysis of variance (ANOVA) was used for assessing
associations between cardiovascular risk factors (diabetes, blood
pressure and dyslipidaemia) and CI quartiles. Because there were
few cases of diabetes, FBS level was used as a proxy of diabetes
association with CI. All statistical analyses were performed by
SPSS version 17 (SPSS Inc, Chicago, IL, USA). A
p
-
value
<
0.05
was considered significant.
Results
Data of 150 menopausal women were completed and included
in the final analysis in this study (response rate 91%). The mean
age of the women was 56.8 years (
±
7.64)
with a range of 42
to 80 years. With regard to education, 85.2% of subjects were
literate. The majority of participating women were housewives
(86.7%)
and 79.3% were married. Only eight women (5.4%) had
diabetes, based on our definition. The physical and laboratory
characteristics of the women are shown in Table 1. Table 2
illustrates the correlation matrix of the variables.
Results show that BMI was positively and significantly
associated with SBP (
r
=
0.21;
p
=
0.009).
WC was positively
and significantly correlated with SBP (
r
=
0.26;
p
=
0.02)
and
DBP (
r
=
0.16;
p
=
0.05).
WHR was positively and significantly
associated with SBP (
r
=
0.29;
p
=
0.001).
CI had a positive
correlation with SBP (
r
=
0.22;
p
=
0.009).
The association of CI
with FBS (
r
=
–0.16)
and triglycerides (
r
=
–0.17)
was weak and
negatively significant.
Because of the small number of subjects with diabetes in
this study, the association between anthropometric measures
and this risk factor for cardiovascular disease was not assessed.
Table 3 shows the risk factor for cardiovascular disease and
anthropometric measures according to quartiles of CI. This table
shows that age and WC were associated with CI quartiles at the
0.05
significance level. The correlation of CI quartiles with SBP
and weight were at the 0.01 significance level.
Discussion
In this cross-sectional study, 165 postmenopausal women were
randomly selected from the Health and Treatment Centre and
Endocrine andMetabolismResearchCentre of Firoozgar Hospital
of Tehran University of Medical Sciences. Correlations of BMI,
WC and CI with cardiovascular risk factors (hypertension, serum
LDL-C and HDL-C, glucose and insulin levels) were assessed.
WC had a significant correlation with SBP and DBP. BMI had
a significant correlation with SBP only. CI had a significant
correlation with SBP.
The findings of our study was similar to those of Taratchuk
and co-workers.
13
They reported that WC and CI were superior to
BMI for identifying visceral adiposity, metabolic disorders and
cardiovascular risk factors.
13
TABLE 1. PHYSICALAND LABORATORY CHARACTERISTICS
OF THE STUDY POPULATION
Variables
Mean SD Min Max
Weight (kg)
64.58 8.10 45.00 84.00
Height (cm)
156.88 6.19 142.00 178.00
BMI (kg/m
2
)
26.11 2.93 18.50 36.00
Waist circumference (cm)
87.18 9.07 67.00 107.00
Hip circumference (cm)
103.11 6.80 88.00 122.00
Waist–hip ratio
0.84 0.07 0.68 1.09
Systolic blood pressure (mmHg)
11.59 1.46 9.00 19.00
Diastolic blood pressure (mmHg)
7.49 0.96 6.00 11.00
Fasting blood sugar (mg/dl)
97.14 43.26 70.00 380.00
Plasma insulin level
8.19 4.26 1.10 24.40
Total cholesterol (mg/dl)
193.14 45.38 110.00 350.00
Triglycerides (mg/dl)
215.02 105.22 70.00 620.00
LDL-C (mg/dl)
111.81 41.93 21.30 260.00
HDL-C (mg/dl)
38.84 6.93 26.00 60.00
Fat mass
43.15 78.69 20.70 69.99
Conicity index
1.24 0.09 1.04 1.50
BMI: body mass index, LDL-C: low-density lipoprotein cholesterol,
HDL-C: high-density lipoprotein cholesterol; SD: standard deviation.
